Why is it so hard to implement change? A qualitative examination of barriers and facilitators to distribution of naloxone for overdose prevention in a safety net environment

摘要: The increase in opioid overdose deaths has become a national public health crisis. Naloxone is an important tool prevention. Distribution of nasal naloxone been found to be feasible, and effective intervention community settings may have potential high applicability the emergency department, which often initial point care for persons at risk overdose. One safety net hospital introduced innovative policy offer take-home via standing order ensure distribution patients aims this study were examine acceptance uptake assess facilitators barriers implementation. After obtaining pre-post data on distribution, we conducted qualitative study. PARiHS framework steered development guide. We used theoretical sampling include range types department staff (50 total). constant comparative method was initially code transcripts identify themes; themes that emerged from coding then mapped back evidence, context facilitation constructs framework. Acceptance good but low. Primary related included: real-world driven with philosophical, clinician leadership support; basic education training efforts; availability resources; ability leave ED kit hand. Barriers fell into five general categories: protocol policy; workflow logistical; patient-related; roles responsibilities; training. actual implementation new innovation healthcare delivery largely by factors beyond acceptance. Despite support resources, challenging, low uptake. While unknown, understanding experience improve setting possible solutions other facilities address Use allowed us recognize understand key contextual successful areas improvement.